The Pathophysiology of Concussive Brain Injury

Authors

• Bradley R. Shane, David Geffen School of Medicine, UCLA Steve Tisch BrainSPORT Program; Department of Pediatrics, University of California Los Angeles, Los Angeles, CA, USA; Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA. Electronic address: bshane@mednet.ucla.edu.Follow
• Ann N. Hoffman, David Geffen School of Medicine, UCLA Steve Tisch BrainSPORT Program; Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA; Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA.
• Mayumi Prins, David Geffen School of Medicine, UCLA Steve Tisch BrainSPORT Program; Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA.
• Christopher C. Giza, David Geffen School of Medicine, UCLA Steve Tisch BrainSPORT Program; Department of Pediatrics, University of California Los Angeles, Los Angeles, CA, USA; Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA.

Document Type

Article

Abstract

Concussion is a complex brain injury affecting neurons and nonneuronal cells such as astrocytes, oligodendrocytes, microglia, and endothelial cells, leading to acute neurometabolic disturbances such as ionic imbalance and energy crisis. Beyond metabolism, these cellular responses may drive inflammation, blood-brain barrier disruption, neuroplasticity, glymphatic dysfunction, and neurodegeneration. Recognizing biological vulnerability and knowledge regarding repeat concussions has shaped protocols to prevent premature return to activity and reduce further injury risk. The concept of concussion and postconcussion endotypes, linking persistent symptoms to specific biological mechanisms, guides targeted diagnosis and treatment. Ongoing research into biomarkers and mechanisms aims to improve prognostication and develop personalized treatments for recovery.

Medical Subject Headings

Humans; Brain Concussion (physiopathology, diagnosis); Biomarkers; Athletic Injuries (physiopathology); Blood-Brain Barrier (physiopathology); Post-Concussion Syndrome (physiopathology)

Publication Date

4-1-2026

Publication Title

Clinics in sports medicine

E-ISSN

1556-228X

Volume

45

Issue

2

First Page

225

Last Page

241

PubMed ID

41786390

Digital Object Identifier (DOI)

10.1016/j.csm.2025.06.002

Recommended Citation

Shane, Bradley R.; Hoffman, Ann N.; Prins, Mayumi; and Giza, Christopher C., "The Pathophysiology of Concussive Brain Injury" (2026). Neurology. 2099.
https://scholar.barrowneuro.org/neurology/2099